Folate has also been in the news regarding its role in osteoporosis. What is folate? How much should I take, and why?

Folate[1], also called folic acid, is well known for its role in preventing spinal cord defects in unborn babies. However, folate also has an important function for everyone—it helps create new cells. One of its most important contributions, either in its natural form found in food or in vitamin supplements, is its role in reducing homocysteine levels. High homocysteine levels are associated with an increased risk of heart disease, stroke, and an increased risk of fracture among older individuals with osteoporosis. Since folate lowers your homocysteine levels, your risk of fracture is also lowered. Some recommend lowering your homocysteine levels by eating fruits, vegetables, and low-fat dairy products, rather than high doses of folate.

In people who have had a stroke, the risk of hip fracture is already increased. High homocysteine levels increase the chances of osteoporotic fractures. Taking folate and vitamin B-^ significantly reduces the risk of hip fractures by lowering homocysteine levels.

Folate's benefits to your health don't stop at bones. Women, particularly younger women, whose intake equals or exceeds the RDA of 400 micrograms of folate per day, reduce their risk of high blood pressure compared to those whose intake is less than 200 micrograms per day.

Getting at least 400 micrograms per day of folate will benefit your bones and your overall health. Most vitamin supplements contain 100% of your RDA of folate. You should not exceed 1000 micrograms. If you do not take a multivitamin, you should be sure to get folate from foods such as spinach, broccoli, chickpeas, black-eyed peas, asparagus, tomato juice, and fortified breads, cereals, and grains (see Questions 47 and 53).

I know there are other vitamins and minerals that are important to bone development. Will I get enough of everything if I take a daily vitamin?

There are several other vitamins and minerals that are vital to your bone development. In addition to calcium, vitamin D, and folate, discussed in previous questions, you should be sure to get enough of vitamins A, B6,C, and K as well as magnesium, manganese, phosphorus, and fluoride. Although vitamin A, sodium, and phosphorus are important to bones, too much of any of them can interfere with bone formation. People were encouraged to drink fewer carbonated beverages because it was believed that they contain too much phosphorus, but, in fact, a 12-ounce can of low-calorie caffeinated soda contains about 50 mg of phosphorus, only 7% of your RDA. Root beer does not contain any phosphorus. Orange juice actually has about as much phosphorus (approximately 5 mg per ounce) as cola does, and calcium-fortified orange juices have as much as five times the phosphorus as cola, but no one has yet raised concern about phosphorus in orange juice. The real problem with drinking excessive amounts of soda is that soda contains many calories with poor nutritional value and often becomes a substitute for milk and other calcium-rich beverages. Vitamin K is part of building healthy bones and has the added bonus of reducing the risk of hip fracture.

Read the label on your daily vitamin supplement, and then compare the listed amounts for the vitamins and minerals necessary for healthy bones with Table 6 and Table 3 (Question 47). Note the difference in the tables among the amounts of vitamins and minerals. Some are dosed in milligrams (mg), some in international units (IU), and some in micrograms (mcg).

If your chosen vitamin supplement does not have 100% of any of these vitamins and minerals, you should be taking an additional supplement. Although technically you could get what you need from a diet, most people do not calculate the vitamin and mineral content of every food they eat. It's probably more practical to take a daily vitamin supplement. Taking a daily multivitamin supplement has overall health benefits including helping you to lose weight and preventing chronic diseases such as heart disease or colon and breast cancer.

New daily vitamin supplements seem to appear on the market every day. Although the ones labeled "For

Table 6 Vitaminsand Minerals for Bone Health

Vitaminsand Minerals for Bone Health

*Note differences in micrograms (meg), milligrams (mg), and international units (IU).

Sources: Harvard Medical School. The Benefits and Risks of Vitamins and Minerals: What You Need to Know. Boston, MA: Harvard Medical School-Harvard Health Publications; 2003.

Fact Sheets, Office of Dietary Supplements, National Institutes of Health. Available at: Accessed August 2005.

and U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and

Human Services, Office of the Surgeon General; 2004.

Bone Health" logically would contain the adequate types and amounts of the vitamins and minerals that you need to maintain healthy bones, this may not be true. For example, different age groups need different amounts of vitamins and minerals. Read labels carefully. The products may also contain substances you don't need at all. For example, men and postmenopausal women usually don't need to take iron because they don't have menstrual periods to lower their iron levels, and they get enough iron in their daily intake of food.

  • [1] A vitamin needed for new cell development; helps reduce levels of homocysteine, a substance associated with osteoporotic fractures, heart disease, and stroke; also reduces risk of breast and colon cancer; also called folic acid. A vitamin found in fruits, vegetables, and low-fat dairy products.
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